Otitis media (OM) is the most common diagnosis made by physicians who care for children, constituting a major health problem in this country. In addition, the state of the knowledge on the subject of OM is lacking in many respects. The epidemiology, natural history, pathogenesis, etiology, diagnosis, management and outcomes of OM are not well established and a significant amount of work lies ahead before these areas can be defined and understood. With this application the University of Pittsburgh -- specifically the Children's Hospital of Pittsburgh (CHP) -- is proposing to establish an Otitis Media Research Center. The core of the proposed center is a series of clinical research studies variously designed to study the efficacy of treatments of OM according to disease stage: acute, recurrent acute and chronic OM with effusion. Some of these clinical studies are currently in progress at CHP, while funding is being sought for others. In addition to these projects are twelve integrated but independent Center projects dealing with various aspects of OM. Preliminary work in these project areas has been well established by the investigators and will form the basis of each proposal. The proposed Center will allow: basic scientists to interact with clinician-scientists in a more intense and formal manner than possible in the past; important questions regarding OM to be answered in an organized manner; patients to flow smoothly from one study to the next depending upon disease stage; the research team to concentrate on research for a reasonable period with financial support; an opportunity to conduct studies, analyze data and publish findings, all leading to the next steps in the development of an organized research approach; this research to be accomplished at a funding level significantly lower than that required for individual research efforts. The presence in Pittsburgh of an experienced, committed research team coupled with the facts that the institutions involved have demonstrated support, adequate clinical and basic research facilities are available, a sufficient number of subjects is attainable, and that patient referral patterns are well established all clearly suggests that the proper time for establishing an Otitis Media Research Center is the present.